Provider Demographics
NPI:1922029586
Name:BOMAR, JOHN C JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:BOMAR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NEIL
Other - Middle Name:
Other - Last Name:BOMAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:115 MORNING MIST LN STE 1
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-8657
Mailing Address - Country:US
Mailing Address - Phone:901-240-3681
Mailing Address - Fax:
Practice Address - Street 1:1044 STATE HWY 48
Practice Address - Street 2:
Practice Address - City:CUMBERLAND FURNACE
Practice Address - State:TN
Practice Address - Zip Code:37051
Practice Address - Country:US
Practice Address - Phone:800-341-7432
Practice Address - Fax:615-789-6596
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0261302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF84388Medicare UPIN